Journal of Vascular and Endovascular Therapy

New developments in the treatment of carotid body tumors from Ecuador where they are common. What is the etiology and the best treatment tricks

3^rd Edition of World Congress & Exhibition on Vascular Surgery
May 24-25, 2018 London, UK

Oscar Ojeda

Hospital Eugenio Espejo, Ecuador

ScientificTracks Abstracts: J Vasc Endovasc Therapy

DOI: 10.21767/2573-4482-C1-002

Abstract

INTRODUCTION: The carotid body tumors belong to the paragangliomas group whose cellular origin is the neuroendocrin extra-adrenal system. The chronic hypoxia is one of the causes. Their diagnosis is based on the clinical presentation and in an image study like ultrasonography, angioCT, angio MR and angiography, this last one at the moment is not of common use and it has been displaced by other techniques. We propose a new classification. PATIENTS: Sixty-nine patients have been analyzed with diagnostic of carotid body tumor, all with unilateral in a 10-year-old period (2007-2017). Twelve men and 57 women. Mean age: 62 years (30-75). Forty of the left side and twenty-nine of right side. The most common form of presentation was an asymptomatic cervical mass. Most of the patients come from the region bigger mountain of cities to 2000 msnm. The diagnosis for more used image was the ultrasonography and the angioCT, in seven cases was not carried out image study. Preoperative embolization with cyanoacrylate and Onyx has been used in tumors bigger than 3 cm prior to surgery. Sixty-eight cases were subjected to surgery and in a case it was not possible the resection for discoveries of malignancy. In all the operated patients the subadventicial technique was used. Thirtyfive patients were classified in tumor type Shamblin I, 21 of type II and 13 of type III. Complications in 12 cases, eight of the type III and four of the type II of Shamblin and they include: tear of the carotid bifurcation, longitudinal angioplasty of the internal carotid and ligation of the external carotid.  Postoperative morbility was presented in 15 cases: disphonia, haematoma of surgical wound and asymmetry of the tongue. There was not mortality. CONCLUSIONS: Ecuador is a country with high prevalencia and incidence of carotid body tumors and this could be justified for the numerous cities that are on the 2000 meters on the level of the sea. The surgical procedure should be carried out by a surgeon with wide experience in technical of carotid reconstruction and handling of vascular and nervous package of neck, for this way to diminish the patient’s morbility and mortality. The embolization should be used in tumors bigger than 3 cm to disminish the risk of bleeding.
Recent Publications 1. Alex Westerband, MD, Glenn C. Hunter, MD, Ismar Cintora, MD, Stanley W. Coulthard, MD, Michael L. Hinni, MD, Andrew T. Gentile, MD, Jennifer Devine, RN, and Joseph L. Mills, MD. Current trends in the detection and management of carotid body tumors, Journal of Vascular Surgery, 1998 28:1 84-93. 2. ALi FIRAT, CUNEYT AYTEKiN, FATiH BOYVAT, NUR ALTINORS, MURAD BAVBEK ,ATILAY TA$DELEN. Multidiciplinary Approach to Carotid Body Paraganglioma: Preoperative Percutaneous Embolization and Surgical Resection. Turkish Nellrosurgery 13: 81-84, 2003 3. Gutierrez, Sanchez, Portillo, Lizola. Paraganglioma carotídeo, Actualidades 2012. Experiencia de 35 años. Revista Mexicana de Angiología, vol 40, numero 1. 2012. 4. Balcazar, López, Soto. Tumor del cuerpo carotídeo de altura. Revisión de 35 años, conceptos actuales y nueva clasificación. Técnicas endovasculares volumen XIV, número 3, diciembre 2011. 5. Christos D. Liapis, M.D., Emmanouil L. Evangelidakis, M.D. Vassilios G. Papavassiliou, M.D., John D. Kakisis, M.D., Alexandros G. Gougoulakis, M.D., Aristidis K. Polyzos, M.D., Michael N. Sechas, M.D., John G. Gogas, M.D. Role of Malignancy and Preoperative Embolization in the Management of Carotid Body Tumors. World J. Surg. 24, 1526–1530, 2000.
 

Biography

Oscar Ojeda is an Ecuadorian vascular surgeon specialized in Argentina. He performed a fellowship in endovascular surgery at Albany Medical Center, USA, and has completed observerships in the most important hospitals in the world (Cleveland Clnic, Mayo Clinic, New York University). In 2016 he received an award from the SVS (International Scholar) and is currently part of the department of vascular surgery of the largest public hospital in Ecuador, the Eugenio Espejo Hospital Email:oscarle1942@gmail.com